E-Cigarettes - LPNI

Are e-cigarettes safe? Do they help people stop smoking? What about teens? What’s recommended? What have we learned today that we didn’t know in 2015?

Our two old foes of formaldehyde and diacetyl -- both known carcinogens for humans -- are still found in many brands of e-cigarettes and vaping products. Researchers continue to agree that e-cigarettes are likely to be less harmful than regular cigarettes, but there are still no long-term studies to back up that claim. E-cigarettes are a very recent product, and cancer can take years to develop. It is difficult to determine a person’s risk of cancer or other long-term health issues until a product has been around for at least 15-20 years.

Two new foes have surfaced: THC and Vitamin E acetate, both strongly linked to the recent outbreak of e-cigarette and vaping-associated lung injury or EVALI. THC has been closely linked to vaping products provided through informal sources, like friends, family, or online dealers. THC is the psychoactive mind-altering compound in marijuana that produces the ‘high’. Vitamin E is an additive found in many foods, supplements and skin-care products. In these forms, vitamin E does not cause harm. However, research suggests that when vitamin E acetate is inhaled, it may interfere with normal lung function. Vitamin E acetate has been found in the lung tissue of patients with EVALI. Its specific role is unclear at this time.

Are e-cigarettes an aid to quit smoking? Here, too, the evidence is unclear. While e-cigarettes help some people quit, there are no high-quality, large-volume studies looking at whether e-cigarettes are effective in helping people quit smoking long-term. Current studies are based on self reporting. In a European study, 85 per cent of adult smokers report they are using vaping/e-cigarettes to help them quit. At the conclusion of the study they were no more likely to quit than regular smokers. Similarly, in the USA participants reported using e-cigarettes to help them quit. However, 6-12 months after being initially interviewed, nearly all were still smoking regular cigarettes. Until there are more controlled studies, the US-FDA has not approved e-cigarettes for use in smoking cessation, and the American Heart Association says e-cigarettes should only be used as a last resort.

The outlook for teens and children is not encouraging either. According to the US National Youth Tobacco Survey, over three million middle school and high school students have tried e-cigarettes. Manufacturers are using candy-like flavors to introduce e-cigarettes and vaping products to teens. Even children who are too young to smoke have been harmed by the liquid. The liquid is concentrated, so absorbing it through the skin or swallowing it has increased the number of emergency room visits and calls to poison control centers to over 200 children a month, with half under the age of two.

What can we recommend? The US-FDA is now regulating e-cigarettes and tobacco products in the same way as cigarettes and smokeless tobacco. Key rules are no-one under age 18 can purchase them in stores or online. Sellers need to check the ID of anyone under 27 years of age and products cannot be sold in vending machines, except in adult-only facilities. Free samples are banned. The American Academy of Pediatrics and the American Lung Association are working to end the sale of candy and fruit flavors that appeal to children and teens. The safest advice continues. If you don’t smoke, vape, or use e-cigarettes, don’t start!

Carol D. Zimmermann, MS, RN

Parish Nurse, Lutheran Church of the Living Christ

Madison, WI 53715 USA, czpeople@gmail.com